Traumatic brain injury (TBI) is the most common cause of death from trauma in children and adolescents and one of the most common causes of acquired disability. Rehabilitation has been viewed as critical to achieving optimal recovery after serious trauma, especially serious TBI. However, there has been limited progress on determining how the organization of rehabilitation care and how the different processes of care are related to functional outcome, especially in children and adolescents. A critical barrier has been the lack of standardized measurement of the organization and processes of care and limited availability of valid measurement criteria for care in the inpatient rehabilitation of injured patients. In this application, we will identify and measure the structure and processes of care in inpatient rehabilitation facilities for pediatric patients with TBI, and examine the variability in these dimensions across rehabilitation facilities and pediatric TBI patients. We will (1) develop a system for measuring the structure and processes of care received by pediatric TBI patients during inpatient rehabilitation. This will be done through a systematic review of the literature and a Delphi process with an expert panel. (2) Evaluate and test a data collection instrument that can be used to collect information on the structure/ organization and processes of care for pediatric inpatient rehabilitation. (3) Use these instruments to examine variations in the structure/ organization of rehabilitation facilities and in the processes of rehabilitation care for pediatric patients with TBI across the US. The long term goal of this study is to deliver optimal care to injured children so that they can attain the best possible outcomes after serious trauma. This proposed project is an essential step in reducing variations in care, and determining which care results in optimal outcomes. Public Health Relevance: The long term goal of this study is to deliver optimal care to injured children so that they can attain the best possible outcomes after serious trauma. This proposed project is an essential step in reducing variations in care, and determining which care results in optimal outcomes.